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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    ROLE OF PROBIOTICS IN IMPROVING GUT HEALTH IN CELIAC DISEASE


    Alexander R. Shikhman, MD, PhD, FACR


    • Journal of Gluten Sensitivity Spring 2012 Issue


    Celiac.com 04/09/2014 - The human gastrointestinal tract contains approximately 1014 bacterial cells that form a unique, diverse and very dynamic microbial ecosystem also known as gut microbiota. The genomes of all intestinal microbes form the “microbiome”, representing more than 100 times the human genome. The composition of gut microbiota is crucial for human health. Normal gut microbiota enhances digestive processes, produces certain vitamins and nutrients, facilitates absorptive processes, participates in development and maturation of the immune system and limits colonization of the gut by pathogenic microorganisms. It has been demonstrated that the following predominant microorganisms constitute for the normal gut microbiota: Bacteroides, Clostridium, Eubacterium, Veillonella, Ruminococcus, Bifidobacterium, Fusobacterium, Lactobacillus, Peptostreptococcus and Peptococcus. Diet is a major environmental factor influencing gut microbiota diversity and functionality.


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    Photo: CC--AJ CannAbnormalities in the composition of normal gut microbiota, also known as dysbiosis, frequently result in the development of chronic inflammatory, autoimmune and atopic processes not only within the gut but also in the distant body compartments such as skin, exocrine glands, the brain, muscles and joints.

    It is well recognized that people affected by poorly controlled celiac disease have detectable dysbiosis.

    Compared to healthy individuals, people with active celiac disease are characterized by higher numbers of Gram-negative bacteria, known to activate pro-inflammatory processes, and lower numbers of Gram-positive bacteria benefiting the gastrointestinal tract and anti-inflammatory responses. Furthermore, recent studies of children with celiac disease showed that even a strict compliance with a gluten-free diet does not completely restore the normal gut microbiota. Di Cagno and colleagues analyzed the composition of gut microbiota in children with celiac disease on a strict gluten-free diet as compared to a group of matched, non-celiac controls. The study showed that the levels of Lactobacillus, Enterococcus and Bifidobacteria were significantly higher in fecal samples from healthy children rather than from celiac children. On the contrary, cell counts of potentially pathogenic microorganisms such as Bacteroides, Staphylococcus, Salmonella, Shighella and Klebsiella were significantly higher in celiac children compared to healthy children.

    Based on the aforementioned data, it is obvious to propose that probiotics, defined as viable microorganisms benefiting gastrointestinal health, may serve as a valuable addition to the maintenance protocols for those with celiac disease.

    Well established probiotic effects include:

    • Beneficial effects on dysbiosis including control of yeast (Candida albicans) overgrowth
    • Facilitation of pathogenic bacteria elimination (for example, Clostridium difficile and Helicobacter pylori)
    • Reduction of local and systemic inflammatory responses
    • Prevention of autoimmune and allergic reactions
    • Prevention and treatment of antibiotic-associated diarrhea
    • Normalization of intestinal contractions and stool consistency
    • Reduction of the concentration of cancer-promoting enzymes and metabolites in the gut
    • Prevention of upper respiratory and urogenital infections
    • Cholesterol-lowering activity
    • Experimental data indicate that probiotics can benefit celiac disease.


    Lindfors K. and colleagues showed that live probiotic, Bifidobacterium lactis, bacteria inhibit the toxic effects induced by wheat gliadin in intestinal epithelial cell culture.

    Papista C. et al. demonstrated (in a mouse model) that probiotics can prevent intestinal damage of celiac disease.

    The published data on the beneficial effects of probiotics in celiac patients is limited. Our clinical experience (Institute for Specialized Medicine – www.ifsmed.com) indicates that appropriately selected probiotics significantly reduce diarrhea and bloating in patients with gluten intolerance and celiac disease. Furthermore, we see positive reduction of gluten-associated joint and muscle pain, fatigue and brain fog as well as on gut colonization with yeast. Probiotics also normalize markers of inflammation (for example, C-reactive protein) and markers of mucosal immune responses (for example, fecal secretory immunoglobulin A – sIgA). Typically, the benefits of probiotics administration cannot be seen instantly. It takes at least 4-6 months to see measurable benefits.

    The choice of probiotics is another difficult issue for an inexperienced consumer.

    The following probiotic strains may benefit those with celiac disease and gluten intolerance:

    a. Lactobacillus acidophilus is a species of Lactobacilli which occurs naturally in the human and animal gastrointestinal tract and in many dairy products. The L. acidophilus strain DDS-1 is one of the best characterized probiotic strains in the world. The medicinal properties of L. acidophilus DDS-1 include: production of lactic acid supporting good bacteria in the gut, production of B and K vitamins, prevention of colon cancer, prevention of ‘traveler’s diarrhea’, inhibition of gastric/duodenal ulcers caused by Helicobacter pylori, reduction of symptoms of eczema and atopic dermatitis, reduction of serum cholesterol level, fermentation of lactose and reduction of symptoms of lactose intolerance, and reduction of intestinal pain.

    b. Lactobacillus plantarum is a Gram-positive bacterium naturally found in many fermented food products including sauerkraut, pickles, brined olives, Korean kimchi, sourdough, and other fermented plant material, and also some cheeses, fermented sausages, and stockfish. The medicinal properties of L. plantarum include: production of D- and L-isomers of lactic acid feeding beneficial gut bacteria, production of hydrogen peroxide killing pathogenic bacteria, production of enzymes (proteases) degrading soy protein and helping people with soy intolerance, synthesis of amino-acid L-lysine that promotes absorption of calcium and the building of muscle tissue, production of enzymes (proteases) digesting animal proteins such as gelatin and helping people with pancreatic insufficiency.

    c. Lactobacillus casei is a species of Lactobacilli found in the human intestine and mouth. The medicinal properties of L. casei include: production of lactic acid assisting propagation of desirable bacteria in the gut, fermentation of lactose and helping people with lactose intolerance, fermentation of beans causing flatulence upon digestion.

    d. Lactobacillus rhamnosus is a species of Lactobacilli found in yogurt and other dairy products. The medicinal properties of L. rhamnosus include: production of lactic acid supporting good bacteria in the gut, production of bacteriocins and hydrogen peroxide killing pathogenic bacteria, prevention of diarrhea of various nature, prevention of upper respiratory infections, reduction of symptoms of eczema and atopic dermatitis, affecting GABA neurotransmitting pathway and reducing symptoms of anxiety.

    e. Lactobacillus salivarius is a species of Lactobacilli isolated from saliva. The medicinal properties of L. salivarius include: production of lactic acid supporting good bacteria in the gut, reduction of inflammatory processes causing colitis and inflammatory arthritis, prevention of colon cancer.

    f. Bifidobacterium bifidus is a Gram-positive bacterium which is a ubiquitous inhabitant of the human gastrointestinal tract. B. bifidus are capable of fermenting various polysaccharides of animal and plant origin. The medicinal properties of B. bifidus include: production of hydrogen peroxide killing pathogenic bacteria, modulation of local immune responses, production of vitamins B, K and folic acid, prevention of colon cancer, bioconversion of a number of dietary compounds into bioactive molecules.

    g. Bifidobacterium lactis is a Gram-positive bacterium which is found in the large intestines of humans. The medicinal properties of B. lactis include: production of hydrogen peroxide killing pathogenic bacteria, modulation of local immune responses, production of vitamins B, K and folic acid, prevention of colon cancer.

    h. Lactococcus lactis is a Gram-positive bacterium used in the production of buttermilk and cheese.  The medicinal properties of L. lactis include: production of lactic acid supporting good bacteria in the gut, prevention of colon cancer, fermentation of lactose and reduction of symptoms of lactose intolerance.

    i. Saccharomyces boulardii is a probiotic strain of yeast first isolated from lychee and mangosteen fruit. Upon consumption, S. boulardii remains within the gastrointestinal lumen, and maintains and restores the natural flora in the large and small intestine.  There are numerous randomized, double-blind placebo-controlled studies showing the efficacy of S. boulardii in the treatment and prevention of various gastrointestinal disorders. Potential indications for use of Saccharomyces boulardii in humans include: 1) diarrhea/traveler’s diarrhea/antibiotic-associated diarrhea, 2) infection with Clostridium difficile/pseudomembranous colitis, 3) irritable bowel syndrome, 4) ulcerative colitis and Crohn’s disease, 5) partial IgA deficiency, 6)peptic-ulcer disease due to Helicobacter pylori. Published data also indicate that enzymes produced by S. boulardii can digest alpha-gliadin and related molecules.

    j. Bacillus coagulans, also known as Lactobacillus sporogenes, is a gram-positive, spore-forming probiotic which is characterized by the increased survival in acidic gastric environment and in bile-acid-associated duodenal environment as compared to the commonly used probiotic microorganisms. Bacillus coagulans do not adhere to the human intestinal epithelium and is completely eliminated in four to five days unless chronic administration is maintained. Once in the intestines, Bacillus coagulans is activated and releases anti-inflammatory molecules or acts indirectly to eradicate organisms in the gut responsible for the inflammatory immune response. Activated Bacillus coagulans produces bacteriocins and lowers local pH by producing L(+) lactic acid that, along with competition for sites of mucosal adherence, works to dislodge and eliminate any antagonizing microbes that may be contributing to an inflammatory response. Bacillus coagulans also produces short-chain fatty acids such as butyric acid, a compound known to support the health and healing of cells in the small and large intestines and to contribute to modulation of the mucosal immune system.

    To achieve therapeutic responses, the daily dose of the probiotics should be at least 25 billion CFUs (colony-forming units) and above. We recommend taking probiotics on an empty stomach either 20-30 minutes before breakfast or one-two hours after dinner with plenty of fluids. In those taking antibiotics, the time of the probiotic administration needs to be spaced out from that of antibiotics for at least several hours.

    References:

    • Papista C, Gerakopoulos V, Kourelis A, Sounidaki M, Kontana A, Berthelot L, Moura IC, Monteiro RC, Yiangou M.  Gluten induces coeliac-like disease in sensitised mice involving IgA, CD71 and transglutaminase 2 interactions that are prevented by probiotics. Lab Invest. 2012 Feb 13. doi: 10.1038/labinvest.2012.13.
    • Sanz Y, De Pama G, Laparra M.  Unraveling the ties between celiac disease and intestinal microbiota. Int Rev Immunol. 2011 Aug;30(4):207-18.
    • de Vrese M, Schrezenmeir J.  Probiotics, prebiotics, and synbiotics. Adv Biochem Eng Biotechnol. 2008;111:1-66.
    • Lindfors K, Blomqvist T, Juuti-Uusitalo K, Stenman S, Venäläinen J, Mäki M, Kaukinen K.  Live probiotic Bifidobacterium lactis bacteria inhibit the toxic effects induced by wheat gliadin in epithelial cell culture. Clin Exp Immunol. 2008 Jun;152(3):552-8.
    • Raffaella Di Cagno, Maria De Angelis, Ilaria De Pasquale, Maurice Ndagijimana, Pamela Vernocchi, Patrizia Ricciuti, Francesca Gagliardi, Luca Laghi, Carmine Crecchio, Maria Elisabetta Guerzoni, Marco Gobbetti, Ruggiero Francavilla.  Duodenal and faecal microbiota of celiac children: molecular, phenotype and metabolome characterization.  BMC Microbiology 2011, 11:219.

    Image Caption: Photo: CC--AJ Cann
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    Guest dappy

    Posted

    Is there a probiotic that can provide these in proper dosage for daily use? I currently take Align which is primarily only one strain.

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    Guest cgilmour

    Posted

    Is there a probiotic that can provide these in proper dosage for daily use? I currently take Align which is primarily only one strain.

    I was just going to ask the same thing. It would be good to know if anyone can recommend a brand.

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    Guest Maddy

    Posted

    I have been taking probiotics for a few months now after having a terrible reaction to long term use of Prevacid . The one I've been using though does not contain all of the strains mentioned in this article.

    Can you help me wade through all the probiotic brands to find the one with the correct strains, strength and is also Gluten Free?

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    Guest sc'Que?

    Posted

    THIS is something that every general practitioner and gastroenterologist needs to read and assign their patients to read when they (all-too-casually) recommend increasing probiotic intake! The description of each species of microbiotum (toward the middle/end of the article) is SO ABSOLUTELY KEY to helping a patient understand what the frak is wrong with himself/herself and why they can't ever seem to feel like themselves. If you have an acquaintance with gluten-intolerance, please pass this along... If you're a doctor, MANDATORY READING.

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    Guest Stella

    Posted

    The gut biome depends on natural feedings of ferment-able foods and butyrate from resistant starches and fibers. You simply cannot supplement with a probiotic for optimal interventions with celiac disease. In addition, the intestinal villi must be evaluated to progression of damage and apply accordingly. New research suggests celiac is a progression of pathogen creating a defunct within the immune system.

    Yours in Health,

    Stella Metsovas B.S.

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    Is there a probiotic that can provide these in proper dosage for daily use? I currently take Align which is primarily only one strain.

    The Keybiotics probrobiotics has all of these except the bacillus coagulans and the saccharomyces .

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    admin

    Celiac.com 03/19/2002 - The following excerpts were taken from The New England Journal of Medicines January 17, 2002 (Vol. 346, No. 30) article on recovery from celiac disease:
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    Approximately 70 percent of patients have symptomatic improvement within two weeks after starting a gluten-free diet. The speed and eventual degree of histologic improvement are unpredictable but invariably lag behind the clinical response and may not be evident on repeated biopsy for two to three months. Although a return to normal histologic findings is common in children, half of adults have only a partial resolution on biopsy. If a patient has no response to the diet, the most common cause is incomplete adherence. Persistent symptoms may be caused by coexisting disorders such as irritable bowel syndrome, lactose intolerance, microscopic colitis, or pancreatic insufficiency.
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    admin

    Celiac.com 03/16/2004 - According to Dr. Erika Jensen-Jarolim, professor of medicine and immunology at the University of Vienna, there may be a connection between the development of food allergies and the use of antacids. Dr. Jensen-Jarolim presented her teams preliminary findings at the World Allergy Congress on September 10, 2003. Individuals who take medications that reduce or neutralize the acidity in the stomach may be at a higher risk of developing food allergies, possibly caused by normally harmless food proteins passing in tact through the digestive system. Normally acid and pepsin break down food proteins before they pass into the digestive tract, and if Dr. Jensen-Jarolim is correct, interrupting this process could cause serious, lifelong consequences. Dozens of over the counter and prescription medications suppress acid production or neutralize it.
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    Am J Gastroenterol. 2005 Jan;100(1):177-85
    Celiac.com 06/30/2005 – In order to determine whether celiac disease mucosal lesions may have a patchy distribution that would require more than one biopsy sample to make an accurate celiac disease diagnosis, Italian researchers closely examined the detailed biopsies taken from 112 consecutively diagnosed children. All of the children in the study had positive anti-endomysium (EMA) or anti-tissue transglutaminase (tTGA) antibodies, and each underwent an upper GI endoscopy in which 4-5 biopsies were taken from Treitz and/or distal duodenum, intermediate duodenum, proximal duodenum, and the duodenal bulb. All biopsies were then classified according to the Marsh criteria. The researchers diagnosed 110 or the 112 patients with celiac disease, and none of the biopsies taken from these children appeared normal. All those diagnosed were positive for HLA-DQ2 or DQ8 genetic markers.
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    Tina Turbin
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    Alessio Fasano, professor of pediatrics, medicine and physiology as well as the director of the Mucosal Biology Research Center and the Center for Celiac Research at the University of Maryland School of Medicine, has been researching celiac disease, paying particular attention to the way intestinal “permeability” influences the development of disease. In an article, published in Scientific American, called “Surprises from Celiac Disease,” Dr. Fasano poses the question of why some celiacs, who are born genetically predisposed to develop the disease, develop symptoms later than others. He suggests that reason for this is associated with the microbiome—the community of bacteria or microbes—living in the digestive tract.
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    I spent years running in circles from doctor to doctor trying to find the cause of my painful symptoms, finally driving me to research my symptoms on my own. I’m grateful to have been properly diagnosed, but managing the gluten-free diet can be a challenge. The prospect of a treatment such as probiotics to offset genetic factors will appeal to many celiacs like myself. Although the treatment for celiac disease is simple, it calls for a lot of work and can be disheartening at times, requiring a total lifestyle change.
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    Jefferson Adams
    Celiac.com 01/11/2012 - In an effort to understand how delayed celiac disease diagnosis became the norm for most patients over the last few decades, a research team conducted a study to assess the issue. Their study also looked at how delayed diagnosis affects health-related quality of life (HRQoL) for those with celiac disease, and considered differences with respect to sex and age.
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    Authors: Fredrik Norstrom, Lars Lindholm, Olof Sandstrom, Katrina Nordyke, Anneli Ivarsson
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    admin
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide.

    WHY A GLUTEN-FREE DIET?
    Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. 
    A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years.
    For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease.
    WHAT ABOUT ENZYMES, VACCINES, ETC.?
    There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease.
    There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes.

    Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. 

    For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement.

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center

    Jefferson Adams
    Celiac.com 04/17/2018 - Could the holy grail of gluten-free food lie in special strains of wheat that lack “bad glutens” that trigger the celiac disease, but include the “good glutens” that make bread and other products chewy, spongey and delicious? Such products would include all of the good things about wheat, but none of the bad things that might trigger celiac disease.
    A team of researchers in Spain is creating strains of wheat that lack the “bad glutens” that trigger the autoimmune disorder celiac disease. The team, based at the Institute for Sustainable Agriculture in Cordoba, Spain, is making use of the new and highly effective CRISPR gene editing to eliminate the majority of the gliadins in wheat.
    Gliadins are the gluten proteins that trigger the majority of symptoms for people with celiac disease.
    As part of their efforts, the team has conducted a small study on 20 people with “gluten sensitivity.” That study showed that test subjects can tolerate bread made with this special wheat, says team member Francisco Barro. However, the team has yet to publish the results.
    Clearly, more comprehensive testing would be needed to determine if such a product is safely tolerated by people with celiac disease. Still, with these efforts, along with efforts to develop vaccines, enzymes, and other treatments making steady progress, we are living in exciting times for people with celiac disease.
    It is entirely conceivable that in the not-so-distant future we will see safe, viable treatments for celiac disease that do not require a strict gluten-free diet.
    Read more at Digitaltrends.com , and at Newscientist.com